Rhinoplasty procedures and complexity

Question

Dear Doctors, Please shed light on what procedures in rhinoplasty are considered simple vs moderate vs complex. examples of 'procedures' being nostril reduction, bulbous tip refinement, de-rotation, bridge refinement, dorsal hump removal, deviated septum, inferior turbinate hypertrophy

David M. Kowalczyk, MD, MBA, FACS · Answer

Hello! There's going to be quite a number of opinions on this. Simple procedures would be things like a minor nasal revision to address a small imperfection at the tip or alarplasty / base reduction for example. Turbinate reduction should be relatively straightforward. Changing variables like rotation and tip refinement increase in complexity. It also depends on if the procedure is open versus closed and if structure in the form of cartilage grafting is employed. Experience plays a role as well. Hope this is useful!

William Portuese, MD · Answer

Rhinoplasty is the most difficult procedure to perform correctly in the entire field of cosmetic surgery, because it is a three dimensional structure, and all of the components of the nose must balance with each other, and the entire new nose must balance with your facial features in a three-dimensional fashion. Always best to choose a rhinoplasty specialist for best results. The bulbus tip is probably one of the more complex maneuvers to perform. Inferior turbinate reduction is one of the easier procedures to perform when there's a breathing difficulty inside the nose.

Robert Ciardullo, MD · Answer

Complexity of various aspects of nasal surgery: before addressing this question we must talk about the word “complexity“ some procedures are more fully in the control of the surgeon’s hand and the outcome more predictable .by your scale these would be considered the least “complex“. Other procedures require more maneuvers and while not technically complex take additional time and effort. Let us refer to these as the “moderately complex“ maneuvers. Other aspects of nasal surgery take multiple maneuvers such as grafts and additional time and have more variable outcomes, and are not entirely within the control of the surgeon. Let us refer to these as the most “complex“. With this clarification the most controllable and least “complex“ aspects of nasal surgery would be reduction of a dorsal hump, and narrowing of a wide Alar base, the so-called alarplasty. In the middle category of procedures which requires some additional time and maneuvers would be de projecting and overly projecting those, elevating a drooping nasal tip ( rotating the tip upward) refining the width of the bridge, and refining a nasal tip which has average thickness skin and Cartilage. Also in this middle category would be repairing a moderately deviated septum or mildly deviated septum. Procedures that require more maneuvers, Cartilage grafting, more time, and have less predictable outcomes would be repairing a severely deviated and twisted septum, a septum which has been traumatized and has a right angle bend, a septum which is crooked in both horizontal and vertical planes causing a cup shape, a septum where the dorsal portion of the septum deviates far from the midline, and multiple other forms of severely twisted and deviated septum. Also in the category of procedures which involve Cartilage grafting and have less successful and less predictable outcomes would be derotating an overly rotated nasal tip and correcting a very bulbous tip with very thick skin. Again, it’s not so much that the procedure is technically difficult to perform , As much as the result is less in the control of the surgeon’s hand and the outcome less predictable and the incidence of revisions highest even in experienced hands. so in short a really good candidate for a high percentage success rate would be a patient with average to thin skin who has a dorsal hump and the worst candidate in terms of percentage success rate would be a patient with an extremely short overrotated nose with a bulbous tip and extremely thick skin which is crooked and obstructed.

Joseph Shvidler, MD · Answer

There is no such thing as a simple rhinoplasty. Rhinoplasty is one of the most complicated procedures in realm of plastic surgery and takes many years of training and experience to perfect. Every person has unique and challenging anatomy. As rhinoplasty surgeons, we have to consider hundreds of variables with each case , whether its someones first or fifth revision surgery.

Rhinoplasty procedures and complexity

Answers (4)

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